ELEVATIONS OF PROCALCITONIN AND D-DIMER IN PATIENTS WITH COVID-19 CORRELATE WITH VENTILATOR-ASSOCIATED PNEUMONIA IN THE SETTING OF VENTILATOR-ASSOCIATED EVENTS AND SPUTUM PRODUCTION

Abstract

TYPE: Abstract TOPIC: Critical Care PURPOSE: It is undetermined whether trending of inflammatory markers in mechanically-ventilated COVID-19 patients is useful in identifying ventilator-associated pneumonia (VAP). The goal of this study is to determine if initial intubation, ventilator-associated events (VAE), or sputum collection was associated with elevations in inflammatory markers, procalcitonin, or positive cultures. METHODS: 287 patients were enrolled in this retrospective study. Data was analyzed into three cohorts: initial intubation, VAE, and sputum collection. Within each group, markers associated with each inciting event were compared to admission values RESULTS: The VAE cohort exhibited differences in WBC (14.1 vs 7.2, p=0.006), d-dimer (4144 vs 881, p<0.001), and CRP (10.4 vs 16, p=0.049). There were no significant differences in procalcitonin and ferritin. The sputum collection cohort revealed differences in WBC (16.8 vs 7.7, p<0.001), procalcitonin (2.95 vs 0.65, p=0.01), and CRP (10.2 vs 15.8, p=0.047). There were no significant differences in FiO2, PEEP, d-dimer, or ferritin. The VAE cohort identified a cultured organism 83% of the time, the initial intubation cohort 35%, and sputum collection cohort 38%. CONCLUSIONS: VAE was associated with a rise in d-dimer, while sputum culture collection was associated with elevated procalcitonin. Interestingly, VAE is suggestive of VAP with an identified organism 83% of the time. Furthermore, d-dimer was associated with VAE and positive organism identification. CLINICAL IMPLICATIONS: This data suggests a role for trending d-dimer and procalcitonin for identification of VAP in setting of a VAE or sputum collection. DISCLOSURE: Nothing to declare. KEYWORD: procalcitonin